Legislators and advocates for the elderly are raising concerns about a state plan to transfer services provided by local Area Agencies on Aging to a for-profit company that has been the focus of previous complaints of poor customer service.
They said they fear the change could lead to delays for seniors who need services and care to remain in their homes and could force people into nursing homes if they are not able to get in-home assistance.
Currently, older Pennsylvanians who need in-home care services through Medicaid have their eligibility for these services assessed – clinically and financially – by local Area Agencies on Aging. But, under a plan from the state’s Department of Human Services, both the assessment and enrollment in the program would be handled by Maximus, a large, multi-national human services company.
The state’s 52 Area Agencies on Aging have been providing the face-to-face assessments for this program for several decades, along with other social services for seniors.
Groups of both Republican and Democratic state legislators have sent letters to the administration of Democratic Gov. Tom Wolf, urging the state Department of Human Services to reconsider.
“We strongly urge the Department to suspend negotiations and reevaluate this approach in the interest of the millions of Pennsylvanians this decision will impact,” wrote a group of state Senate Democrats.
State human service officials said that Maximus was the highest scoring applicant in its request for applications process, and was selected to begin contract negotiations, though they noted a final agreement has not been signed.
A “procurement blackout period” is still in effect, which limits what can be disclosed publicly, DHS officials said. The state also noted the Area Agencies on Aging (AAAs) have filed a protest to the procurement.
Maximus has handled enrollment responsibilities for the program – though not assessments – since 2016. It faced complaints about poor customer service from advocates, seniors, and state legislators when it took this aspect over from the AAAs. At a 2016 legislative hearing about the enrollment switch from AAAs to Maximus, advocates complained of a burdensome application process, lost documents, months-long delays, and a lack of assistance to help seniors complete what are often complex forms, among other problems.
“We would have these clients in their 80s and 90s who desperately needed these services and were just stuck for months in the application process,” recalled Pam Walz, supervising attorney in the Health and Independence Unit at Community Legal Services in Philadelphia. Things did eventually improve after legislative hearings and staffing changes, she said.
In 2012, the state settled a lawsuit brought by a disability rights group over lengthy waits for individuals who had disabilities who were applying for Medicaid-funded home and community based services through Maximus, though the company was not part of the litigation.
“We fear that selecting a multi-billion-dollar corporation with no local ties to Pennsylvania’s seniors and [Medicaid] waiver-eligible communities will cause further delays in connection to services and result in increased costs to our healthcare system – impacting all Pennsylvanians,” Senate Democrats wrote in their letter to the administration last week.
A number of AAA officials declined to comment for this story, citing the possibility of litigation.
But legislators and senior advocacy groups praised the work the Area Agencies on Aging have done.
“The AAAs and the Centers for Independently Living have forever been relied upon for their expertise in this area. Not only have they served our seniors and adults with disabilities for over three decades, they are the only local entity with the knowledge and understanding of our complex Medicaid and long-term care system to be able to quickly and efficiently assist our constituents in understanding the services available to them,” said a letter from Senate Republicans to Meg Snead, the state’s Acting Secretary of Human Services.
The state’s plan “appears to eliminate… the role of the Triple As in this process. And that's a loss, a loss of those community partners statewide that are relied on by seniors, and we're alarmed by that,” said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project, a nonprofit law firm that assists Pennsylvanians who need help obtaining health care through the state’s Medicaid program.
The Pennsylvania AARP also sent a letter to the state last week in support of the work the local aging agencies have done.
Seniors applying for the assistance can have serious medical or cognitive issues and need help with daily activities such as dressing and feeding themselves, said Mildred Morrison, who ran Allegheny County’s Area Agency on Aging for 17 years.
“I'm not talking, once a week, come mow the lawn,” she said of the assistance. “I'm talking, who will literally help one get out of bed? And then, how will one spend the day by oneself in a, not just pleasant but in a safe manner, as well as one that is respectful and caring for that senior.”
Based in northern Virginia, Maximus bills itself as a leader in providing services for government health and human services such as Medicaid, the Children’s Health Insurance Program, Medicare and numerous other public programs.
The company didn’t comment but said it is “committed to supporting the most vulnerable Medicaid beneficiaries and have done so for more than a decade in Pennsylvania and with more than 20 other states.”
